Cora Sandigan (not her real name) lives in the Philippines capital, Manila, with her 10 children. Her husband is a public transport driver and earns about US$6 a day.
“After my fourth child, I was denied birth control pills at the health centre because of a city ordinance banning artificial contraceptives,” Sandigan, 36, said.
In 2000, then Manila Mayor Lito Atienza passed Executive Order (EO) 003, which prohibited modern contraceptive methods and sterilization in the city’s 10 public health facilities.
Many of the urban poor rely on government facilities for contraception, yet the Catholic Church remains immovable in advocating only for traditional family planning methods, labelling condoms and birth control pills abortifacients.
Sandigan, who leads a hand-to-mouth existence, used to get the pills free from the public health clinic. She cannot afford the $0.86 to buy them in the pharmacy, much less the cost of tubal ligation - $62 - in a private hospital.
In 2008, 20 residents of Manila, including Sandigan and her husband, filed a petition to repeal EO 003.
“EO 003 is a violation of a couple’s right to privacy and health. It is not for the state to determine how couples should plan their families,” Beth Pangalangan, an attorney representing the petitioners, told IRIN in Manila.
“All the petitioners are of legal age, married or in long-term relationships. They are not promiscuous or engaged in the sex trade industry,” she said.
The petition was dismissed by the Court of Appeal on a technicality and the case is still pending in the Regional Trial Court.
The Department of Health (DoH) estimates about three million pregnancies in the Philippines annually. The 2003 National Demographic & Health Survey indicated a total fertility rate of 3.5 children per woman, while the desired fertility rate averaged 2.7 - most Filipino women have one child more than they actually want.
However, Claire Padilla, executive director of Engenderights, a legal NGO that advocates for reproductive self-determination, contests this finding. “That may be true on a national average, but in reality, the poor women of Manila have 6-10 children.”
Photo: UNFPA Philippines
mortality remains a key challenge for the Philippines. Approximately
4,500 women die each year from complications due to child birth
House Bill 5043 on Reproductive Health institutionalizes government funding and access to both modern and traditional family planning services.
However, strong pressure from the church to promote traditional family planning and its substantial influence on the voting public, who are 80 percent Catholic, pose a threat to its passage - it has been blocked for 20 years.
In the absence of national legislation, local government units can exercise their authority to set their own laws such as the Manila City Ordinance EO 003.
Tale of two cities
In contrast, Quezon City, the largest in Metro Manila, has taken a more progressive stance on family planning.
“The Philippines is the world’s 12th most populous nation. Quezon City’s population of 2.5 million increases by 1.92 percent annually. This hugely impacts [on the] allocation of government resources,” Councillor Joseph Juico says.
Juico is the principal sponsor of the Quezon City Population and Reproductive Health Management Policy, which allows all forms of contraception and sterilization in public health clinics.
Prior to its passage, local parish priests launched a campaign calling Juico and fellow councillors “followers of the devil”.
“PowerPoint presentations stating that modern contraceptives cause cancer and promote promiscuity were made during homilies,” Juico told IRIN.
Citing data from the DoH-Field Health Service Information System, which compared Manila and Quezon City, Juico says: “We were able to reduce the number of maternal deaths through various reproductive health city initiatives since 2001.”
According to separate studies, the maternal mortality rate (MMR) declined in Quezon City, from a high of 14 deaths per 100,000 live births in 1997 to about three per 100,000 in 2006; while in Manila, it declined from a peak of about 12 deaths per 100,000 in 2005 to about seven per 100,000 in 2006.
However, a 2009 UN Children’s Fund report, The State of the World’s Children, shows that the Philippines has an MMR average of 230 per 100,000 live births. Health officials predict the 2015 Millennium Development Goal of 55-60 per 100,000 live births will not be met.
There is some hope on the horizon, with the approval of the Magna Carta for Women (MCW) last August, aimed at guaranteeing women’s basic rights and freedoms, including that of reproductive self-determination, although it has yet to be officially implemented.
“The repealing clause of the MCW states that any existing conflicting legislation, whether national or local, will be deemed repealed, modified or amended. Any questions in this regard will have to be brought to court,” Senator Pia Cayetano, principal author of the MCW, told IRIN.